Food Commercialization, Hidden Hunger and Malnutrition: A Study of Food and Nutrition Security focusing on the Marginalized Society in Sri Lanka Dissertation for the acquisition of the academic degree Doktor der Agrarwissenschaften (Dr. agr.) Submitted to the Faculty of Organic Agricultural Sciences of the University of Kassel Written by W.A. Permani Chandika Weerasekara Witzenhausen, September 2020 The Faculty has approved this work of Organic Agricultural Sciences of the University of Kassel as a thesis for acquiring the academic degree of Doctor of Agricultural Sciences (Dr. agr.). Prof. Dr. Chandana Rohana Withanachchi, Rajarata University of Sri Lanka, has been part of the supervisor team and co-author of all three publications. First Evaluator: Prof. Dr. Angelika Ploeger, University of Kassel, Germany. Second Evaluator: Dr. Christian Hülsebusch, DITSL, University of Kassel, Germany. Examiner: Prof. Dr. Claudia Neu, University of Kassel and the University of Göttingen, Germany. Examiner: Prof. Dr. G.A. Sanjeewanie Ginigaddara, Rajarata University of Sri Lanka. Die vorliegende Arbeite wurde vom Fachbereich Ökologische Agrarwissenschaften der Universität Kassel als Dissertation zur Erlangung des akademischen Grades eines Doktors der Agrarwissenschaften (Dr. agr.) angenommen. Prof. Dr. Chandana Rohana Withanachchi, Rajarata University of Sri Lanka war Mitglied im Betreuungsteam in Sri Lanka und Co-Autor der drei Publikationen. Erste Gutachterin: Prof. Dr. Angelika Ploeger, Universität Kassel, Deutschland. Zweiter Gutachter: Dr. Christian Hülsebusch, DITSL und Universität Kassel, Deutschland. Prüferin: Prof. Dr. Claudia Neu, Universität Kassel und Universität Göttingen, Deutschland. Prüferin: Prof. Dr. G.A. Sanjeewanie Ginigaddara, Rajarata University of Sri Lanka. The oral defense 4 th of March 2021. Table of contents Table of content i List of figures iv List of tables v List of abbreviations vi Preface vii Acknowledgements viii Summary 1 Zusammenfassung 3 1. Chapter 1: General introduction 5 1.1. Background of the study 5 1.2. Theoretical background 7 1.2.1. The causes of malnutrition and micronutrient deficiencies in society 7 1.2.2. Food systems commercialization 9 1.2.3. Healthy food for a healthy life and a sustainable diet 10 1.2.4. Food insecurity and nutrition problems 11 1.2.5. Nutrition transition 14 1.2.6. Food and nutrition situation in Sri Lanka 15 1.3 Research profile 17 1.4 Research gap 20 2. Chapter 2: Objectives and structure of the thesis 22 2.1. Objectives 22 2.2. The structure of the thesis 23 3. Chapter 3: Methods and materials 24 4 Chapter 4: Nutrition Transition and Traditional Food Cultural Changes in Sri Lanka during Colonization and Post-Colonization 26 4.1 Introduction 26 4.2 Theoretical Framework 28 4.3 Materials and Methods 31 4.4 Results 31 4.4.1. Ancient and Traditional Food Habits and Food Culture in Sri Lanka 31 4. 4.2. Nutrition Transition after Colonization 35 4.5. Discussion 38 4.6. Conclusions 41 5. Chapter 5: Food and nutrition-related Knowledge, Attitudes, and Practices among reproductive-age women in marginalized areas in Sri Lanka 46 5.1 Introduction 46 i 5.2 Materials and Methods 48 5.2.1. Study Area 48 5.2.2. Study Design and Data Collection 49 5.2.3. Questionnaire 50 5.2.4. Data Analyses 52 5.3 Results 52 5.3.1. Demographic Characteristics of Reproductive-Age Women 52 5.3.2. Food and Nutrition-Related Knowledge 53 5.3.3 Food and Nutrition-Related Attitudes 55 5.3.4. Food and Nutrition-Related Practices 56 5.3.5. Multiple Linear Regression to identify factors that affect Food and Nutritional Knowledge 57 5.3.6. Risk-Factor Analysis 58 5.3.7. Correlation Analysis between BMI Level and Women’s Knowledge about the Perception of Food Quality 59 5.4. Discussion 59 5.5. Conclusions 62 6. Chapter 6: Understanding Dietary Diversity, Dietary Practices and changes in Food Patterns in Marginalized Societies in Sri Lanka 71 6.1. Introduction 72 6.2. Materials and Methods 73 6.2.1. Study Areas 73 6.2.2. Study Sample 73 6.2.3. Minimum Dietary Diversity of WRA (MDD-W) 74 6.2.4. Assessment of Food and Nutrient Intakes and health condition 74 6.2.5. Health Condition 74 6.2.6. Biodiversity and diet, policy and practice 74 6.2.7. Anthropometric Measurements 74 6.2.8. Statistical Analysis 75 6.3 Results 75 6.4 Discussion 84 6.5 Conclusions 89 7. Chapter 7: General discussion 96 8. Chapter 8: Conclusion 102 8.1. Scientific contribution 102 8.2 Policy contribution and recommendation 103 8.3. Insight for future research 104 8.4 Limitations 104 9. Erratum 105 10. Bibliography of the thesis and appendix 106 ii Appendix 01: Ethical certificate 127 Appendix 02: Consent form 128 Appendix 03: Field questionnaire 1 (English version) 130 Appendix 04: Field questionnaire 1 (Sinhala version) 135 Appendix 05: Field questionnaire 2 (English version) 139 Appendix 06: Field questionnaire 2 (Sinhala version) 144 Appendix 07: Field questionnaire 3 (English version) 146 Appendix 08: Field questionnaire 3 (Sinhala version) 147 Appendix 09: Selected pictures from the field work 149 Appendix 10: Selected pictures of traditional food in Sri Lanka 152 iii List of figures Figure 1.1: Cause of malnutrition and micronutrient deficiencies 8 Figure 1.2: Drivers of food system changes 10 Figure 1.3: Level of food security 12 Figure 1.4: Connection between food access and nutritional outcomes, underlying causes of food insecurity and nutrition problems 13 Figure 1.5: Distinctions and overlaps between hunger, food insecurity, nutrition insecurity and undernutrition 13 Figure 1.6: Study area map 19 Figure 4.1. Percentage mortality by cause in Sri Lanka (2014) 29 Figure 4.2. The conceptual framework for the colonial and postcolonial dynamics of food culture 30 Figure 4.3. Growth in total food consumption in Sri Lanka. Source: Central Bank Reports from 1950 to 2001 38 Figure 4.4. Child micronutrient deficiency in Sri Lanka 39 Figure 4.5. Female malnutrition based on body mass index (BMI) 39 Figure 5.1. Study map (authors’ illustration). 49 Figure 6.1. MDD-W 10 food groups of reproductive-age women in both areas 77 Figure 6.2. Percent consuming low nutrient density food groups 82 Figure 7.1: Multiple complex factors beyond personal decisions strongly influence dietary choices and patterns 97 Figure 7.2: Field interviews and survey near Kebithigollawa in Anuradhapura with senior people 98 iv List of tables Table 1.1: Population by GN division 20 Table 3.1: The summarization of methods and materials in this research 24 Table 4.1. Colonial and postcolonial dynamics 30 Table 4.2. Traditional wild fruit in Sri Lanka 32 Table 4.3. Traditional food items in ancient Sri Lanka 33 Table 4.4. New variety of food introduced by the Portuguese 36 Table 4.5. A new variety of food introduced by the Dutch 36 Table 5.1. The study questions of food and nutrition-related knowledge and attitude. 50 Table 5.2. Demographic characteristics of reproductive-age women 52 Table 5.3. Each dimension of the average score indifference (knowledge) variables 54 Table 5.4. Knowledge level of reproductive-age women in urban and rural areas in Sri Lanka regarding nutrition 55 Table 5.5. The average score of food and nutrition-related attitude 55 Table 5.6. Reproductive-age women’s food practices in rural and urban areas of Sri Lanka 56 Table 5.7. Multiple linear regressions to identify factors that affect food and nutritional knowledge of reproductive-age women in rural and urban areas of Sri Lanka 57 Table 5.8. Correlation analysis between the knowledge level of reproductive-age women in Sri Lanka and BMI 58 Table 5.9. Correlation analysis between socioeconomic and environmental factors and BMI. 58 Table 5.10. Correlation analysis between BMI levels and reproductive-age women’s perception of food choices. 59 Table 5.11. Correlation analysis between BMI levels and reproductive-age women’s perception of food quality. 59 Table 6.1. Demographic and social-economic characteristics of reproductive age women(N=400) 75 Table 6.2. The types of food that are consumed in reproductive-age women in marginalized areas 77 Table 6.3. Commonly used traditional food varieties in rural areas 79 Table 6.4: Minimum Dietary Diversity score of women of reproductive age (MDD-W) 81 Table 6.5. Associations between MDD-W and selected socioeconomic indicators 82 Table 6.6. Self-reported health conditions 83 Table 6.7. Selected macro and micro vitamins and mineral intake 84 v Frequently used abbreviations FAO Food and Agriculture Organization MDD-W Minimum Dietary Diversity of Women of reproductive age WRA Women of Reproductive Age WHO World Health Organization NCDs Non-Communicable Diseases DD Dietary Diversity KAP Knowledge Attitude Practices DS Divisional Secretariat GN Grama Niladari ERC Ethical Review Committee BMI Body Mass Index VIF Variance Inflation Factor UN United Nations IFAD International Fund for Agricultural Development WFP World Food Programme USDA United States Department of Agriculture UNICEF United Nations International Children's Emergency Fund ECDPM European Centre for Development Policy Management LTTE Liberation Tigers of Tamil Eelam GDP Gross National Products Hb Hemoglobin IFPRI International Food Policy Research Institute ADB Asian Development Bank FRAC Food Research Action Center MSG Monosodium Glutamate WDDS Women Dietary Diversity Score EAR Estimated Average Requirements vi Preface The basis for this research stemmed from my background and experiences. The Research study was funded by the “Katholische Akademische Ausländer Dienst (KAAD)“, Germany and the “Verein zur Förderung einer natur- und sozialverträglichen Ernährungs- und Landschaftskultur e.V.“ in Germany, and DAAD STIBET programme in Germany. This doctoral study mainly investigates food commercialization, hidden hunger and malnutrition in marginalized societies in Sri Lanka.